6-month-old baby girl with symptoms of abdominal pain and vomiting. She has been relatively healthy apart from being colicky in the evenings until about 3 months of age. During the last 2 weeks, the mother has been giving her additional feedings of cow's milk formula by bottle in an attempt to begin weaning. However, after the first few bottles, the baby showed signs of acute stomach pain and immediately vomited all the milk. These symptoms have recurred each time she has been fed by bottle.
Physical examination
Looks healthy, quite plump. Abdomen slightly distended and taut.
Suspected diagnosis
IgE-mediated cow's milk allergy?
Diagnosis & follow-up
After a two-week diet, replacing cow's milk with a casein hydrolysate formula, the child is symptom-free. Laboratory results show a positive ImmunoCAP
® Phadiatop® Infant test and positive IgE antibodies to cow's milk of 16 kU A /L. Plan to continue milk-free diet until 12 months of age and then perform a new IgE antibody test for cow's milk to see if there is a decrease in IgE antibodies in order to decide if a milk challenge test could be performed.